In Reply to Shemtob

We thank Ms. Shemtob for her thoughtful response to our article. She makes the important point that reflection as a tool is an unfamiliar concept and one that does not come naturally. We would add that this is especially true in the context of medical education with its well-known associated pressures and situating one’s learning within a vast and ever-increasing body of knowledge. While Ms. Shemtob suggests that students must develop their own styles of reflection and opportunities to reflect, we want to propose that medical education can and must create opportunities for shared reflective practice and perhaps even methods for reflective practice that resonate with the context and content of clinical practice. This position takes the view that reflective practice does not need to consist of exclusively solitary and self-directed thought but can also include collective dialogue and interactions with others. If Ms. Shemtob is suggesting that the “independent end” for reflection is personal development or improvement of practice, we would add that it could potentially encompass much more. Flexibility, as she indicates, is certainly the key. Perhaps, as many students believe, reflection or reflective practice cannot be taught; however, a caveat would be that various methods for reflective practice can be taught. While many programs currently encourage reflection through reflective writing, there are nevertheless countless other means to facilitate reflective practice, including journals, portfolios, movie reviews, and even art, some of which Ms. Shemtob alludes to in her own practice. Notably, a global context for reflective practice in medical education also takes on some significance for medical educators who seek to transfer skills and practices to international settings, especially in countries that have histories of colonization or deference to ways of knowing from the developed world. Here medical educators must also engage actively in critical reflection to respond respectfully and effectively to the contextual needs of medical education outside of Western industrial societies. The concepts of cultural humility and contextual reflexivity can serve as orientating mechanisms to guide the process. Thirusha Naidu, PhDClinical psychologist, Department of Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa; [email protected] Arno Kumagai, MDVice chair for education, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

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